Evaluating the Effectiveness of an eHealth EBI for Latino Youth in Primary Care

美国的西班牙裔青少年经历了显著的健康差异，特别是与药物有关的健康差异。 使用、不安全的性行为和性传播感染。尽管存在这些差异， 西班牙裔青少年存在有效的预防干预措施，甚至更少已经传播 （IOM/NRC，2009）。鉴于初级保健环境越来越成为通过 父母给青少年带来了行为健康问题，青少年初级保健机构是理想的， 但未得到充分利用的环境，以传播循证预防干预措施。预防 针对家庭内的风险和保护因素的干预措施， 影响人类行为的社会制度，已被发现是最有效的干预措施之一， 预防和减少吸毒和危险性行为。 Familias Unidas是一种针对西班牙裔的、以家庭为基础的干预措施，被发现在以下方面是有效的和有效的： 预防和减少药物使用、性风险行为和自我报告的性传播感染。Familias Unidas一直是 医学研究所关于年轻人预防、情绪和行为的报告引用了这一点， 准备广泛传播（IOM/NRC，2009）。然而，迄今为止，Familias Unidas仅进行了以下测试： 在学校的功效和效果，并没有评估在初级保健的功效/效果。我们 已经调整和评估了Familias Unidas的在线交付;成功地保留了80%的西班牙裔 家长和他们的年轻人（从学校招募）在网上，电子保健改编的家庭联合会。我们有 还表明了在初级保健中提供“家庭联合电子保健”的可行性和可接受性。 评估西班牙裔青年基于家庭的创新电子健康干预措施，其可行性和 在初级保健环境中建立可接受性是及时的，具有高度的公共卫生意义。因此，我们认为， 这项研究的首要目标是评估电子健康的相对有效性和成本效益 家庭团结，与国家药物滥用研究所（NIDA）在线信息页面的推荐相比 西班牙裔青年的父母（以下简称NIDA在线信息）。的有效性进行测试 eHealth Familias Unidas Primary Care在预防吸毒、无保护的性行为和性传播感染方面的作用 西班牙裔青年的普遍样本，这项研究将随机选择456西班牙裔青年和他们的父母到eHealth Familias Unidas或NIDA在线信息。将在基线、6、12、24和36时对受试者进行评估 基线后月数。研究假设是：1）相对于NIDA，电子健康家庭联盟将是有效的 在线信息，在预防/减少吸毒、无保护的性行为和性传播感染发病率方面， 西班牙裔青少年随着时间的推移和2）干预效果将部分介导的家庭功能， 药物使用和无保护的性行为以及家庭功能和无保护的性行为对性传播感染的影响 发病率。还将估计电子保健家庭联合会在三年随访期间的成本效益。

Hispanic adolescents in the U.S. experience significant health disparities, particularly as it relates to drug use, unsafe sexual behaviors and sexually transmitted infections (STIs). In spite of these disparities, a paucity of effective preventive interventions exist for Hispanic adolescents, and even fewer have been disseminated widely (IOM/NRC, 2009). Given that primary care settings are increasingly becoming the entry-point through which parents bring youth with behavioral health concerns, adolescent primary care settings represent ideal, yet underutilized, settings in which to disseminate evidence-based preventive interventions. Preventive interventions which target risk and protective factors within the family, the most proximal and fundamental social system influencing human behavior, have been found to be among the most efficacious interventions in preventing and reducing drug use and sexual risk behaviors. Familias Unidas is a Hispanic-specific, family-based intervention found to be efficacious and effective in preventing and reducing drug use, sexual risk behaviors, and self-reported STIs. Familias Unidas has been cited by the Institute of Medicine report on Preventing, Emotional, and Behavioral among Young People as ready for broad dissemination (IOM/NRC, 2009). To date, however, Familias Unidas has been only tested for efficacy and effectiveness in schools and has not been evaluated for efficacy/effectiveness in primary care. We have adapted and evaluated Familias Unidas for online delivery; successfully retaining 80% of Hispanic parents and their youth (recruited from schools) in the online, eHealth adaptation of Familias Unidas. We have also demonstrated the feasibility and acceptability of delivering eHealth Familas Unidas in primary care. Evaluating innovative eHealth family-based interventions for Hispanic youth whose feasibility and acceptability is established in primary care settings is timely and of high public health significance. Therefore, the proposed study's overarching aim is to evaluate the relative effectiveness and cost effectiveness of eHealth Familias Unidas, compared to a referral to the National Institute Drug Abuse’s (NIDA) online information page for parents of Hispanic youth (referred hereafter as NIDA Online Information). To test the effectiveness of eHealth Familias Unidas Primary Care in preventing drug use, unprotected sexual behavior, and STIs in a universal sample of Hispanic youth, this study will randomize 456 Hispanic youth and their parents to eHealth Familias Unidas or to NIDA Online Information. Participants will be assessed at baseline, 6, 12, 24, and 36 months post baseline. Study hypotheses are that: 1) eHealth Familias Unidas will be effective, relative to NIDA Online Information, in preventing/reducing drug use, unprotected sexual behavior, and STI incidence in Hispanic adolescents over time and 2) Intervention effects will be partially mediated by family functioning for drug use and unprotected sexual behavior and by family functioning and unprotected sexual behavior for STI incidence. The cost effectiveness of eHealth Familias Unidas over a three year follow up will also be estimated.